Critical Care Newsline — September 25, 2008

Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN’s clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.

1. EVIDENCE How Often Do Nurses Recognize Delirium in Their Patients? (Abstract)
Can nurses tell if their elderly patients are experience delirium? According to a review of the literature, there’s a wide range of responses; nurses reported they recognized the problem from 26% to 83% of the time. Why so much variation? According to reviewers, a nurse’s knowledge, recognition, assessment and documentation of delirium in older adults are different. Because delirium is prevalent, costly and global in older adults, the reviewers recommend practice changes that will help nurses more easily identify the condition.

Learn more about delirium by viewing our new e-learning program, “Promoting Excellence in Palliative and End-of-Life Care: An Interactive Learning Experience from AACN.” If your organization already has an AACN E-Learning system site license, you can immediately access this program. If your hospital doesn’t have a site license, ask about obtaining one so you and your colleagues can take advantage of all AACN’s innovative e-learning courses.

2. NEWS AACN and AONE Launch CNML Certification for Nurse Managers
The Certified Nurse Manager and Leader (CNML) credential, a collaborative effort between AONE Credentialing Center and AACN Certification Corporation, is now available. Inaugural CNML testing will begin at more than 170 assessment centers nationwide for an introductory period of Oct. 1-31, 2008. Testing will resume on a permanent basis beginning Jan. 5, 2009. The CNML credential gives nurse managers a way to validate their knowledge as they strive to excel in their demanding roles, carrying out complex leadership responsibilities that directly affect the quality of patient and family. Register by Oct. 10, 2008 to test during this introductory period and qualify for a 30% group discount (for groups of 10 or more).

3. CALL TO ACTION Submit Your Best Practices on Building a Culture of Certification
If you’ve been involved in successfully establishing a culture of certification at your workplace or through your AACN chapter, we want to hear from you. Send us your best practices by filling out the online submission form where you can describe your best practice, your role in the process and the barriers you and your colleagues faced implementing it. You can submit a best practice anytime but if your submission is received by Oct. 17, it may be one of those selected for presentation in the mastery session,” Building a Culture of Certification: Best Practices Roundtable”, at NTI 2009 in New Orleans.

4. EVIDENCE Post-traumatic Stress Disorder Prevalent in ICU Survivors (Abstract)
Thanks to advances in critical care medicine, patients admitted to the intensive care unit today are more likely than ever to survive their stay. Yet outliving the physical trauma or illness that required ICU treatment often leaves long-lasting psychological scars, according to a review of the literature. “The prevalence of post-traumatic stress disorder symptoms and PTSD in patients following ICU hospitalization is high — about 20 percent,” reviewers reported. “Considering that about 4 million people visit the ICU every year in the U. S. alone, it’s a significant public health issue.” One of the review’s limitations, which the authors acknowledge, is that most of the included studies used screening questionnaires to identify PTSD symptoms. “Screening tools are not really the gold standard for PTSD assessment,” reviewers reported, adding that the best action for healthcare providers is to thoughtfully prepare families for the possibility that their loved one could have psychological difficulties, including problems with anxiety and PTSD after an ICU stay.

In a related study, researchers found that family members may experience post-traumatic stress as many as six months after a loved one’s stay in the intensive care unit. Symptoms of anxiety and depression in family members diminished over time, but high rates of post-traumatic stress and complicated grief remained, the authors noted.

5. NEWS Surgeon General’s Call to Action: Prevent Deep Vein Thrombosis and Pulmonary Embolism
Acting Surgeon General Steven K. Galson recently issued a Call to Action to reduce the number of cases of deep vein thrombosis and pulmonary embolism in the U. S. He urged all Americans to learn about and prevent these treatable conditions. "Deep vein thrombosis and pulmonary embolisms are often 'silent' conditions — they can occur suddenly and without symptoms," Galson said. “We want to increase the awareness and knowledge of these potentially deadly conditions and encourage patients and healthcare providers to take the steps to prevent them."

For more on this topic, read AACN’s Practice Alert on Deep Vein Thrombosis Prevention.

6. RESOURCE Guides to Prevent, Treat Deep Vein Thrombosis, Pulmonary Embolism
Two new guides to help consumers and clinicians prevent and treat deep vein thrombosis were recently released by the Agency for Healthcare Research and Quality (AHRQ). AHRQ’s consumer booklet, “Your Guide to Preventing and Treating Blood Clots,” is an easy-to-read resource that helps patients and their families identify symptoms of dangerous blood clots, learn how to prevent them and know what to expect during treatment. The clinician guide, “Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement,” is a comprehensive tool to help hospitals and clinicians implement processes to prevent dangerous blood clots. The 60-page guide details how to start, implement, evaluate and sustain a quality improvement strategy.

Treatment for blood clots often includes blood thinning medications such as Coumadin (warfarin). AHRQ recently published “Your Guide to Coumadin/Warfarin Therapy” to help patients taking this medication better understand their treatment.

7. EVENT Symposium on Functional Genomics, Critical Illness and Injury Nov. 17-19
The 6th Annual Functional Genomics of Critical Illness and Injury Symposium will be held Nov. 17, 2008 in conjunction with the inaugural meeting of the U.S. Critical Illness and Injury Trials Group Nov. 18 and 19 at NIH headquarters in Bethesda, Md. The Nov. 17 symposium will include an updated on genetic predisposition in the ICU and will cover new technology for physiological genomics. The two-day critical illness and injury meeting will cover strategic planning, clinical trial design and ethics, and other topics pertinent to establishing national priorities for critical illness and injury research.

Benefits and Risks of Tight Glucose Control in Critically Ill Adults: a Meta-analysis (Abstract)

Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

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